Provider Demographics
NPI:1841204245
Name:CHADHA, GURBACHAN S (MD)
Entity Type:Individual
Prefix:
First Name:GURBACHAN
Middle Name:S
Last Name:CHADHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5110 W CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60651-2901
Mailing Address - Country:US
Mailing Address - Phone:773-287-2200
Mailing Address - Fax:773-379-9001
Practice Address - Street 1:5110 W CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60651-2901
Practice Address - Country:US
Practice Address - Phone:773-287-2200
Practice Address - Fax:773-379-9001
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
1238047OtherECFMG
49529630116OtherAMA
D13144Medicare UPIN
IL981610Medicare PIN